Prostate Cancer

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Prostate cancer is a very serious and very common form of male cancer. Its occurrence in recent times is increasing and it is certainly appropriate to have some information about this type of cancer. The tumor process comes from the prostatic gland, which is a male organ located in the pelvic area just below the urinary bladder. It is also anatomically very close to the rectum. The urethra passes through the prostate towards the penis. During ejaculation, the prostate releases its secretion, which makes up approximately one third of the volume of ejaculate. Substances in prostatic fluid are important for nutrition and longer survival of the sperm in female genital tract.


Prostate cancer

Prostate cancer



The causative factors are not entirely clear. Male gender, of course, is a clear risk factor as women have no prostatic gland. Age factor is also of a great importance. The majority of prostate cancers occur in males above 50 years of age and the incidence grows with the age. During autopsies, early stages of prostate cancer are incidentally found in many men older than 80. Higher incidence of prostate cancer was observed in men with positive family history of prostatic cancer in close relatives. Male hormone testosterone has usually a positive impact on the tumor as it accelerates its growth and progression.


The question is the influence of chronic inflammations of prostate (chronic prostatitis) that often accompanies sexually transmitted diseases (such as gonorrhea). Chronic inflammatory irritation of tissues is generally related to higher risk of cancers, but we are uncertain in this case. Other possible risk factors may include obesity and smoking. It is a logical assumption as the cigarette smoke worsens oxidative stress and includes many carcinogenic substances.


Prostate cancer is unfortunately asymptomatic for a long time. The tumor process is initially limited to the prostatic tissue and the patient has no problems. Later, the problems mimic simple benign prostatic enlargement including more frequent urination at night, intermittent urination and feeling of imperfect emptying. Sometimes, the urination may be painful and blood in urine may occur. Larger tumors may significantly compress the urethra causing disruption of urinary outflow, urine accumulation and recurrent urinary infections. Advanced tumors growing into the urethra can also cause pain during ejaculation. The tumor can spread into local lymph nodes and it typically forms distant bone metastases. Bone metastases manifest with bone pain and occurrence of pathologic fractures. Advanced prostatic with numerous metastases may lead to classic symptoms of advanced cancer processes such as fatigue, elevated body temperature, night sweats, weight loss, etc.


A patient with above-mentioned symptoms should not be ashamed and visit a urologist. The urological examination includes digital rectal examination as the prostatic tissue can be palpated by a finger through the rectal wall. Healthy prostate should be soft and well palpable, prostatic cancer is very hard on touch. Blood tests are important for further diagnosis as we have a tumor marker known as PSA, whose concentration rises in case of benign enlargement of prostate (mild elevation) and prostate cancer (significant elevation).


The local extent of the tumor may be evaluated by ultrasound or computed tomography, bone metastases may be found by bone scintigraphy. Prostatic biopsy may be performed to get tissue samples of the prostatic gland to confirm the presence of tumor and to evaluate its histological attributes. The prostatic biopsy is done by a needle, which is inserted into the prostate through the rectal wall.


The therapy is individual and it depends on cooperation between urologists and oncologists. Local surgical intervention is the best option and when the tumor has not yet spread, it is an absolutely curative alternative. The surgery aims to remove the tumor and the prostatic tissue (prostatectomy).


Chemotherapy and radiotherapy are also used, but their effect is not brilliant. However, palliative irradiation of bone metastases is great in reducing the bone pain. Irradiation of prostate and the pelvic area may cause development of radiation colitis.


Hormonal therapy is effective as it uses the fact that testosterone promotes the growth of the tumor. The principle of treatment is therefore removal of the testosterone from the body of the patient. This can be achieved either by removing the testes (i.e. castration) or by administration of special medications that decrease testosterone concentration.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources